Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

BMC Cardiovascular Disorders

Ban Liu¹  Chunyan Han¹  Xiang Li²  Wen Ge³  Zhi Li⁴  Yangyang Zhang⁵  Lingtong Shan⁶  Mengwei Lv⁷ 

[1] Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, 200072, Shanghai, People’s Republic of China;Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, People’s Republic of China;Department of Cardiothoracic Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, People’s Republic of China;Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China;Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, People’s Republic of China;Department of Thoracic Surgery, Sheyang County People’s Hospital, Yancheng, Jiangsu, People’s Republic of China;Department of Thoracic Surgery, Yancheng Third People’s Hospital, The Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng, Jiangsu, People’s Republic of China;Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Shanghai, People’s Republic of China;Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, People’s Republic of China;

关键词: EuroSCORE II;    Cardiac troponin t;    Coronary artery bypass grafting;    Off-pump;    Mortality;   

DOI  :  10.1186/s12872-020-01745-1

来源: Springer

【 摘 要 】

BackgroundPreoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG).MethodsThis retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis.ResultsThere were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively).ConclusionsBoth myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.

【 授权许可】

CC BY